Islet transplantation improves vascular diabetic complications in patients with diabetes who underwent kidney transplantation: A comparison between kidney-pancreas and kidney-alone transplantation

Paolo Fiorina, Franco Folli, Paola Maffi, Claudia Placidi, Massimo Venturini, Giovanna Finzi, Federico Bertuzzi, Alberto Davalli, Armando D'Angelo, Carlo Socci, Chiara Gremizzi, Elena Orsenigo, Stefano La Rosa, Maurilio Ponzoni, Massimo Cardillo, Mario Scalamogna, Alessandro Del Maschio, Carlo Capella, Valerio Di Carlo, Antonio Secchi

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74 Scopus citations

Abstract

Background. The aim of this study was to evaluate the effects of islet transplantation on patient survival and diabetic vascular complications. Methods. Thirty-seven type 1 uremic diabetic kidney transplant patients underwent islet transplantation (KI group). Uremic type 1 diabetic kidney-pancreas (KP group, n=162), kidney-alone (KD group, n=42) transplant patients, and uremic type 1 diabetic patients still on hemodialysis (HD+DM group, n=196) constituted the control groups for survival and endothelial morphology. Results. Patient survival was similar in the KI and KP groups and higher than in the HD+DM group (P<0.05). Patients experiencing long-term islet function (KI-successful [KI-s], n=24) showed a better survival (100%, 100%, and 90%) than those in the KI group who lost islet function (KI-unsuccessful [KI-u], n=13) (84%, 75%, and 45%) at 1, 4 and 7 years, respectively (P=0.02). The cardiovascular death rate for the KI group (18%) was similar to the KD group (19%) but lower when the KI-s group is considered alone (5%), and showed a cardiovascular death rate similar to the KP group (8%). The KI-s group showed a good metabolic profile, with reduction of exogenous insulin requirement and persistent C-peptide secretion, as compared with the KI-u group. The endothelial morphology was evaluated with a skin biopsy obtained in all groups. The KI-s and the KP groups demonstrated decreased signs of endothelial injury compared with the KI-u and HD+DM groups. The KI group showed a better atherothrombotic profile than the HD+DM group, with higher levels of natural anticoagulant protein. Conclusions. Successful islet transplantation improves survival, atherothrombotic profile, and endothelial morphology in uremic type 1 diabetic kidney transplant patients.

Original languageEnglish (US)
Pages (from-to)1296-1301
Number of pages6
JournalTransplantation
Volume75
Issue number8
DOIs
StatePublished - Apr 27 2003

ASJC Scopus subject areas

  • Transplantation

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